Case From My Note-Book. [Volume: 2, Issue: 7, February, 1861, pp. 363-365]

CASE FROM MY NOTE-BOOK.

365

the cotton. I applied creosote three times, which, reducing the inflammation sufficiently, I followed by nerve paste, but exceedingly weak,
being fearful, with her high nervous organization and her recent terrible
ordeal of irritation, of raising another excitement. In applying it I
placed a very minute quantity of creosote containing that proportion of
caustic (arsenic) which it would simply hold in solution immediately upon
the pulp, laid a cap of lead over, and over this a small bit of tissue paper
moistened in saliva, which forms a pulpy, soft, adhesive, and excellent
covering. I gave directions to apply to me at once, in the event of any pain
of great severity or duration. In the afternoon she called and told me
she felt all the premonitory symptoms of her previous attack: pain in her
temples, face, etc. I removed the application, washed the cavity with a
syringe containing warm water and cologne, and applied creosote. I dismissed her with injunctions to call upon me only, if she had any neuralgic trouble or any other trouble with her head. The pain gradually
ceased, and on the next call, which was in two or three days, I again applied the caustic for destruction of the nerve, and continued gradually and
almost imperceptibly to kill, and to soothe, until I had the satisfaction
to reach the apex, remove the entire pulp, and pronounce the operation a
thoroughly healthy one. I filled the root with a worm of cotton, the
point armed with creosote, filled the crown with gutta-percha, and told her
to return in a week. During the destruction of this pulp her confidence
in me was firm, her mind decidedly made up, but her fears of a return of
her attack very great, and not without reason, as in two or three instances
the symptoms were such as to cause me to withdraw the caustic and
soothe the nerve, when they would subside.
On the expiration of the week she called. I found no irritation had
followed the "test," no symptoms of periostitis whatever; everything indicating a thoroughly healthy condition of the tooth and surrounding
parts. I filled its pulp cavity and then its crown. It is now, December
fifteenth, perfectly healthy, and no single symptom of trouble in her
mouth or head has been experienced since. She also informs me of a
gain of ten pounds to her weight, which she attributes to good health, freedom from pain, and particularly to her continued shower baths. The above
case bears directly upon the long and interesting article of Dr. McQuillen
on the fifth pair of nerves, and is a case in point illustrating how necessary it is to carefully examine the teeth ere treating neuralgic symptoms.
An accomplished member of our profession would have relieved my patient infive minutes of all her "neuralgia," without any information from
her of what had been previously done to her mouth 1 Under a mistaken
diagnosis, she suffered nearly a month most terribly, was unconscious over
a week, and under heavy expense through the whole.
WASHINGTON, D. C., January 15, 1861.